The Personal Ordinariate of Membership Registration the Chair of St. Peter This 2-page form is to be completed by each individual who wishes to declare canonical membership in the Personal Ordinariate of the Chair of St. Peter. Families should complete a form for each member of the family who wishes to be considered for Ordinariate membership. (Please staple or bind family forms together.) Those who are eligible for membership in the Ordinariate must be able to answer “YES” to one or more of the following questions (CHECK ALL THAT APPLY): • Are you a former Anglican, Methodist, or member of an ecclesial communion that includes those of Anglican heritage (United Church of Canada, Charismatic Episcopal Church, etc.) who is now in full communion with the Catholic Church? Yes No • Are you a current Anglican or Methodist intending to be received into the Catholic Church AND currently enrolled in adult catechesis to be received into the Catholic Church? Yes No • Are you a Roman Catholic in full communion with the Catholic Church AND who has a family member(s) who is (are) a canonical member(s) of the Ordinariate? Yes No • Have you completed or are you a candidate for any or all of the Sacraments of Initiation through an Ordinariate or Pastoral Provision parish? Yes No • Are you a Roman Catholic in full communion with the Catholic Church AND who has a family member(s) who is (are) a candidate(s) for any or all Sacraments of Initiation through an Ordinariate or Pastoral Provision parish? Yes No If you can affirm one or more of the above statements, you are eligible for consideration of canonical membership in the Personal Ordinariate of the Chair of St. Peter. Please complete ALL fields below and submit this form to your local Ordinariate Parish Pastor or Parochial Administrator or, in the absence of a local Ordinariate Parish, to the Ordinariate Chancery at: Personal Ordinariate of the Chair of St. Peter, P.O. Box 55206, Houston, TX 77255. If you cannot affirm one or more of the above statements, you are still strongly encouraged to register as a parishioner in an Ordinariate parish and participate fully in the life of your local Ordinariate parish. 1. Contact Information To expedite the processing of your application, please PRINT CLEARLY.  There is no Ordinariate Local Ordinariate Parish/Parochial Community: parish/community near me (Circle One) Mr. | Mrs. | Ms. | Miss | Dr. | Other:

First Name: (Optional) Middle Name:

Last Name:

If married, Spouse's Full Name:

Mailing Address:

City, State/Province, Zip/Postal Code, Country:

Preferred Phone Number (Home Cell Office):

Preferred Email Address:

YES NO: I wish to receive emails from the Personal Ordinariate of the Chair of St. Peter and my local Ordinariate parish/community. (If YES: I give permission to add my email address [provided above] to email mailing lists for regular communications about the Ordinariate and my local Ordinariate parish/community.) (OVER) | Last revised July 2017 2. Age Information

Date of Birth (MM/DD/YYYY):

If you are under age 14, have your parents given consent to your request for membership in the Personal Ordinariate of the Chair of St. Peter? YES NO

3. Sacramental Information

Marital Status: Single Married Divorced Widowed

If married, Church & Date of Marriage (MM/DD/YYYY):

Baptized? YES NO

If yes, Church & Date of Baptism (MM/DD/YYYY):

Confirmed in the Catholic Church? YES NO

If yes, Church & Date of Confirmation MM/DD/YYYY( ):

4. Children Please share the name(s) and birth date(s)/age(s) of any child/children. (Please continue on separate sheet, if needed.) Name(s) Birth Date(s) Age(s) as of ______(Today's date)

5. Petition for Membership It is my desire to belong to the Personal Ordinariate of the Chair of St. Peter. I have made my Profession of Faith and have received the Sacraments of Initiation in the Catholic Church, or will receive the Sacraments of Initiation through the Ordinariate. My signature on this form is the canonical act by which I manifest my desire to enter the Personal Ordinariate of the Chair of St. Peter.

Signature (Required)

Date (Required)

By completing and signing this form, you agree that the information provided to the Ordinariate can be used to: create a record of your request for membership; administer our Ordinariate records; contact you in relation to the ministries, activities, and outreach of the Ordinariate and its Parishes and Parochial Communities. Those under age 14 should complete a form but do not need to sign the petition, since they join the Ordinariate with their parents or guardians. Signed, dated, and completed forms should be returned to your local Ordinariate Parish/Community Pastor/Parochial Administrator or, in the absence of a local Ordinariate Parish, to the Ordinariate Chancery: Personal Ordinariate of the Chair of St. Peter | P.O. Box 55206 | Houston, TX 77255 Original, signed application forms must be delivered to the Parish/Parochial Community or the Chancery for the application to be processed. Forms sent via email to the Chancery will not be processed without receipt of the hard copy form. YOUR MEMBERSHIP IS NOT COMPLETE UNTIL YOU HAVE RECEIVED CORRESPONDENCE FROM THE ORDINARIATE CHANCERY VERIFYING RECEIPT AND APPROVAL OF YOUR REGISTRATION. To inquire about the status of your application, please email [email protected]. Please allow several months for the review of your registration form.

Office Use Only: Parish - OTC | Chancery: NID SP SAL SDL SDL-C